Carbapenem use in critically ill patients.

PURPOSE OF REVIEW: To review available data on carbapenem use in ICU. Carbapenem is a broad spectrum well tolerated antibiotic family that keep an excellent activity to extended spectrum β-lactamases and AmpC hyperproducer and in susceptible Pseudomonas aeruginosa and Acinetobacter baumannii. It becomes a drug of choice for empirical therapy of suspected sepsis in known or presumably known ESBLE carriers.

RECENT FINDINGS: Carbapenems remained the drug of choice for severe ESBLE infections. In severe critically ill patients, high off-label dose is necessary especially in patients with sepsis and glomerular hyperfiltration. Nevertheless, large spectrum of carbapenems leads to initial overuse. The increase in the overall consumption in the past years with lack of systematic re-evaluation observed is responsible of and carbapenem-selection pressure that contribute to the increase of carbapenem-resistant enterobacteriaceae, A. Baumannii and P. Aeruginosa in ICUs.

SUMMARY: Carbapenems remained a cornerstone of antibiotic therapy of severe infections. Emerging carbapenem resistance is related to the increase of carbapenem consumption. High doses are recommended for early therapy followed by systematic reevaluation on a daily basis with shift to narrow spectrum antimicrobials if possible and early stopping rules.